While driving to the clinic, Ms. Blue thought about what she would tell her doctor. She didn’t want to come across as needlessly anxious, but she wanted him to understand how unwell she felt. Was there something wrong with her?
Upon entering the office, she was promptly shown into an examination room. Only three minutes behind the scheduled appointment time, Dr. Rush entered the room.
“Ms. Blue,” he greeted, extending his arm. They shook hands and he sat down on the rolling stool. “I understand you’re not feeling well?”
“Well, I think I might—well, you see, I’ve been really tired lately.” Ms. Blue paused. “My dad died about a month ago. I haven’t been able to sleep.”
Ms. Blue and her father had always been close, though they increasingly relied upon each other for support in the past five years. Her mother’s memory was steadily worsening over time. Prior to his death, her mother periodically woke up in the middle of the night and tried to leave the house, believing that she had to go to work. She remembered less and less of her history with her husband with each passing day. He never cried when he talked with Ms. Blue, though his weariness and sadness were obvious. Since his passing, her mother had moved in with Ms. Blue and her family. Neither Ms. Blue nor her mother were adjusting well to the change. Any energy she had was now gone and—
“I’m sorry to interrupt, but we’re running out of time,” Dr. Rush said. “So you’re not sleeping well, you’ve been feeling depressed, you’re tired—all understandable. I’m sorry for your loss.”
“Thank you,” Ms. Blue said, wiping her eyes.
“With all that has happened, have you had any thoughts about wanting to be dead?”
“Oh, no, no. Nothing like that. I just wish I didn’t feel this way.”
Dr. Rush nodded, putting the earbuds of his stethoscope into his ears as he said, “Let me listen to your heart and lungs, just to make sure they sound okay.” His gaze settled into the middle distance as he moved his stethoscope first across her back, then over her chest. After pushing on her belly and murmuring, “Everything’s fine,” he sat back onto the rolling stool.
“Maybe we can talk more about this next time, in about a month? And, in the meantime, you can try an antidepressant. You might start feeling better and have more energy,” Dr. Rush said, checking his watch before taking the prescription pad out of his pocket.
“You think I need an antidepressant?” Ms. Blue quietly asked.
“It probably won’t hurt,” Dr. Rush said. He scribbled something onto his prescription pad, tore the top sheet off, and handed it to her. “Some people experience side effects—sleepiness, dry mouth, stomach discomfort—but those usually go away in a few days. It might help.”
“Thank you,” she said, tucking the script into her purse.
“You’re welcome. I’m sorry that our time was cut short, but they have me on a tight schedule,” Dr. Rush murmured. They said good-bye.
She walked out of the office, feeling both relief and dismay. On the one hand, Dr. Rules apparently didn’t think that she had a major medical condition. On the other hand, she wondered if she really needed an antidepressant. Was her condition that bad?
While going through his charts later that evening, Dr. Rush spread his arms out to loosen his shoulders. He sighed.
“If only I didn’t have to see so many people in a day,” he mumbled. “I might actually be able to help people more. I can’t possibly do a thorough job in fifteen minutes.”
He heard a knock on his door. The clinic manager stuck her head into his office. “Only one no-show today. Your productivity numbers have been great. Our reimbursement will be high this month. Good work!”
A weak smile crossed his lips and she ducked out of the office again. When he looked down, he saw Ms. Blue’s chart in front of him. He wondered what she didn’t tell him today.
This is part of a series about why some physicians write many prescriptions for psychiatric medications. You can read more stories here.
Maria Yang, MD 